tbuckley/cabot-search huggingface dataset:
Abstract P215: Inflammatory and Insulinemic Dietary Patterns Are Associated With Modestly Increased Total and Cardiometabolic Mortality Among Low-Income Americans
Authors: Chandler Montgomery, Jae Jeong Yang, Martha Shrubsole, Ravi Shah, Danxia Yu
Journal: Circulation (2023)

Introduction: Diet is a modifiable risk factor for cardiometabolic morbidity and mortality, potentially via increased inflammation. Two hypothesis-oriented dietary patterns, the empirical dietary inflammatory potential (EDIP) and empirical dietary index for hyperinsulinemia (EDIH), have been linked to increased risk of cardiometabolic diseases and overall mortality. However, their associations with total and cause-specific mortality in Black Americans and populations of low socioeconomic status (SES) have not been described. Hypothesis: We assessed the hypothesis that higher EDIP and EDIH scores are associated with increased total and cause-specific mortality in a low SES and predominately Black population. Methods: In the Southern Community Cohort Study, a prospective cohort of mostly low-income Black and White adults recruited from 12 Southeastern states in the US, we included 77,209 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had been followed-up for mortality outcomes through 2019. The EDIP and EDIH scores were estimated based on 18 components derived from the FFQ. Cox proportional hazard models were used to estimate hazard ratios (HRs) of total and cardiometabolic mortality for the highest vs. lowest quintiles (Q5 vs. Q1) of EDIP/EDIH, adjusting for sociodemographics, lifestyles, and history of major chronic diseases. In a subgroup of 5,162 participants with data on blood levels of high-sensitivity C-reactive protein (hs-CRP), we also evaluated the correlations of EDIP and EDIH with hs-CRP. Results: Of 77,209 participants, 46,233 (59.9%) were women, 49,925 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. During an average follow-up of 12.9 years, we documented 20,028 total deaths, including 6,296 from cardiovascular disease and 1,150 from diabetes. Higher EDIP and EDIH scores were both associated with increased total and cardiometabolic mortality. EDIP and EDIH Q5 vs. Q1 HRs were 1.10 and 1.11 for total mortality, respectively (95% CIs: 1.05-1.16 and 1.06-1.17), 1.20 and 1.15 for cardiovascular mortality, respectively (95% CIs: 1.11-1.31 and 1.06-1.25), and 1.38 and 1.34 for diabetes mortality, respectively (95% CIs: 1.13-1.67 and 1.10-1.63); all p-trend ≤0.001. EDIP and EDIH weakly correlated with hs-CRP, despite statistical significance (r=0.058 for EDIP and 0.081 for EDIH; both p&lt;0.0001). Conclusions: In conclusion, empirical inflammatory and insulinemic dietary patterns are associated with modestly increased inflammation and total and cardiometabolic mortality among low-income Black and White Americans. Efforts to improve nutrition may improve overall cardiometabolic health and prognosis.
Abstract 56: DNA Methylation of Birthweight-Blood Pressure Genes and Changes of Blood Pressures in Response to Weight-Loss Diets
Authors: Minghao Kou, Xiang Li, Xuan Wang, Hao Ma, Yoriko Heianza, George Bray, Frank M Sacks, Lu Qi
Journal: Circulation (2023)

Introduction: DNA methylation (DNAm) may play a critical role in bridging prenatal adverse events and cardiometabolic disorders including hypertension in later life. Hypothesis: DNAm levels of genes related to both birthweight and blood pressure were associated with changes in blood pressures in response to dietary weight-loss interventions. Methods: We included 672 adult participants with overweight or obesity, who participated in a 2-year randomized weight-loss dietary intervention study. Baseline blood DNAm levels were profiled by high-resolution methylC-capture sequencing. We defined the regional DNAm levels as the average methylation level within 500 bp of LINC00319 (cg01820192), ATP2B1 (cg00508575), and LMNA (cg12593793). Generalized linear regression models were used to assess the association between the regional DNAm and 2-year blood pressure changes. Trajectory analysis was used to identify subgroups that shared a similar underlying trajectory of 2-year blood pressure changes. Results: We found that the regional DNAm at LINC00319, but not the other genes, showed different associations with 2-year changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) among participants assigned low- or high-fat diets (P for interaction &lt; 0.05 for all, Figure ). In response to low-fat diet, per standard deviation higher regional DNAm at LINC00319 was associated with greater reductions in both 2-year changes in SBP (β: -1.481; standard error [SE]: 0.632; P = 0.020) and DBP (β: -1.096; SE: 0.413; P = 0.009). Three trajectories of changes in SBP and DBP were identified, and participants with higher baseline regional DNAm at LINC00319 were less likely to have stable or increased blood pressure levels. Conclusions: Our findings indicate that higher regional DNAm level at LINC00319 was significantly associated with greater long-term reduction in blood pressure in response to a low-fat diet, suggesting people with higher regional DNAm levels benefited more from eating a low-fat weight-loss diet.
Abstract P150: Residential Segregation and Hypertension Risk in Black and White Americans
Authors: Debora Kamin Mukaz, Andrew Sparks, Timothy B Plante, Suzanne E Judd, George Howard, Virginia J Howard, April P Carson, Lorraine Dean, Geoff Dougherty, Mary Cushman
Journal: Circulation (2023)

Introduction: Black adults experience the highest hypertension burden of any American group. Evidence indicates social factors adversely affecting Black people explain some of the excess hypertension burden. It’s unclear whether residential segregation, a key cause of health inequities, has a differential impact on Black and White people. Hypothesis: The magnitude of the association of residential segregation and risk of incident hypertension will be greater in Black than White people. Methods: Our sample included 6,143 Black and White REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants without prevalent hypertension (2003-7), and with a follow-up visit 9.3 years later. Baseline county-level segregation was measured with the (1) dissimilarity index (DI, the difference in race distribution of census tracts relative to their county), (2) isolation index (ISI, the degree to which Black people are exposed only to one another in a county), and (3) interaction index (ITI, the degree to which Black people are exposed to White people in a county). Modified Poisson regression estimated the risk ratios (RR) of incident hypertension per SD increment of baseline residential segregation. Results: The mean (SD) age was 61(8) years for Black people and 62(8) years for White people. Hypertension incidence was 46% for Black people and 33% for White people. There was no association of any of the three measures of residential segregation (DI, ISI and ITI) with incident hypertension, with RRs all around 1.0 ( Figure ). Conclusions: Three measures of residential segregation were not associated with incident hypertension risk in Black and White participants of the REGARDS cohort. Findings differ from a previous study that reported that a measure of racial clustering was associated with higher risk of hypertension in Black people. Taken together, findings suggest that, in Black people, different domains of residential segregation capture factors related differently to hypertension development.
Abstract P335: Prognostic Cut Point of Fasting Insulin in Apparently Healthy Young Adults for the Development of Future Cardiovascular Disease
Authors: Joshua Garza, Alok Dwivedi, David P Cistola
Journal: Circulation (2023)

Introduction: Early metabolic imbalance (EMI) is insidiously prevalent in the U.S., especially among teens and young adults. It includes markers of insulin resistance, inflammation and oxidative stress, but does not meet the criteria for metabolic syndrome. Individuals with EMI have compensatory hyperinsulinemia, an independent risk factor for CVD. Yet, fasting insulin is an underutilized prognostic marker, partly due to a lack of calibrated cut points for this population. Hypothesis: The prognostic value of insulin for CVD risk is associated with an optimum cut point, which can be calibrated using a time-dependent receiver operator characteristic (timeROC) analysis of CARDIA: Coronary Artery Risk Development in Young Adults. Methods: The parent CARDIA study began in 1985, enrolling 5,114 participants ages 18-30 at baseline, with 35-year follow-up. In our retrospective cohort analysis, the exclusion criteria were hyperglycemia, hypertriglyceridemia, low HDL, pregnancy, diabetes, CVD, or fasting &lt; 8 hours, all at baseline; n=3,292. The primary outcome was time to incident CVD (or censor), defined as fatal/nonfatal MI, coronary revascularization, acute coronary syndrome, CHF, stroke, TIA, carotid or peripheral artery disease. Survival data were analyzed using the ‘timeROC’ package in R v.4.2.1, with/without adjustment for the 2019 ACC/AHA risk factors for CVD. For validation, a conventional ROC (logROC) analysis was performed, with incident CVD as the outcome. For timeROC and logROC, the cut point optimum was determined using minimum distance to the [0, 1] coordinate; predictive accuracy was summarized by area under the curve (AUC). The prognostic value of insulin at its optimum was determined using Cox regression for insulin alone and with risk factors, using Stata v.17.0. Cox results are summarized with hazard ratio (HR) and Harrell’s c-statistic (c). Results: The cut point optimum for baseline fasting insulin was 9.1 mIU/L (60.5 percentile), with AUC 0.583 (95% CI: 53.6, 62.9), sensitivity 54.8% and specificity 61.7%. The results were unchanged with/without covariate adjustment in timeROC, and with logROC. Using the optimum, the unadjusted Cox HR for high vs. low insulin was 1.9 (95% CI 1.4, 2.6, p&lt;0.0001); c=0.580. Cox model 2 included a variable with both high insulin and high waist circumference (WC); HR for both vs. neither condition was 2.6 (95% CI 1.8, 3.8, p&lt;0.0001); c=0.606. Cox model 3 added ACC/AHA risk factors to model 2: HR 2.2 (95% CI 1.5, 3.4, p&lt;0.0001) for high insulin and WC vs. neither; c=0.716. Conclusion: For young adults in CARDIA without metabolic syndrome or prediabetes, the cut point optimum for fasting insulin is near the top tertile. Insulin has a high prognostic value for CVD, especially when combined with WC. Though useful, insulin suffers from modest sensitivity. Better markers of EMI are needed for assessing hidden CVD risk in apparently healthy young adults.
Abstract P196: Metabolomic Associations With Cardiac Function and Incident Heart Failure in Multi-Ethnic Populations
Authors: Eun Hye Moon, Taryn Alkis, Guning Liu, Kunihiro Matsushita, Ron C Hoogeveen, Christie M Ballantyne, Brian Claggett, Qibin Qi, Robert C Kaplan, Carlos J Rodriguez, Amil M Shah, Bing Yu
Journal: Circulation (2023)

Introduction: Measures of cardiac structure and function provide important diagnostic and prognostic information for heart failure (HF). Few studies have assessed the associations of circulating metabolites with cardiac structure and function. Hypothesis: We hypothesize that circulating metabolites that reflect aging process are associated with cardiac structure and function measures and incident HF. Methods: Participants from the Atherosclerosis Risk in Communities (ARIC) study visit 5 and the Hispanic Community Health Study / Study of Latinos (HCHS/SOL) study visit 1 who had serum metabolite measures but not prevalent HF were included. Linear regressions were used to examine the associations of metabolites with ten cardiac structure and function variables adjusting for clinical risk factors in each race and study strata, followed by random-effect meta-analyses. The Cox regression was applied to examine the relationship between those identified metabolites and incident HF post visit 5 in ARIC. Results: Among 589 analyzed metabolites, 179 were associated with cardiac structure or function measures in 706 Blacks, 3,358 Whites, and 1,380 Hispanics (FDR &lt; 0.05). Forty-one metabolites were related to two or more measures, where 22 were associated with incident HF (308 HF cases, p&lt;0.05, Figure). Metabolites were more associated with cardiac size or diastolic function compared to systolic function measures, i.e., C-glycosyltryptophan, an amino acid that is strongly correlated with age, was positively associated with left ventricular mass index (LVMI) and left atrial volume index(LVAI), as well as an increased risk of HF (HR=1.48); and dodecadienoate (12:2), a dicarboxylate that may have anti-aging property, was negatively associated with LVMI and LVAI, as well as a decreased risk of HF (HR=0.84). Conclusions: We identified multiple metabolites associated with cardiac structure and function measures in multi-ethnic populations, highlighting metabolic pathways in aging and their impact on HF.
Abstract P300: Peripheral Neuropathy is Associated With All-Cause Mortality Among Older Adults in the Atherosclerotic Risk in Communities Study
Authors: Caitlin W Hicks, Dan Wang, Kunihiro Matsushita, B Gwen Windham, Elizabeth Selvin
Journal: Circulation (2023)

Background: Peripheral neuropathy (PN) as assessed by monofilament testing (decreased sensation in the foot) is associated with mortality. The mechanisms by which PN increases mortality risk are unclear but may be partially explained by fall risk, a major contributor to morbidity and mortality in older adults. Hypothesis: We aimed to assess the hypothesis that PN is associated with all-cause mortality in older adults, and that this association may be partially explained by increased susceptibility to falls. Methods: We conducted a prospective cohort analysis of 3371 Black and White participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing at visit 6 (2016-2017; age 71-94 years). We used Cox models to assess the associations of PN with mortality before and after accounting for the intervening occurrence of injurious falls or fractures as identified using hospitalization discharge codes. Results: At visit 6, PN was prevalent in 34.6% of participants (overall mean age 79.4±4.7 years, 58.7% female, 20.9% Black, 32.5% had diabetes). During a median of 2.6 years of follow-up there were 602 falls or fractures (PN=22% vs. no PN=16%) and 219 deaths (PN=9.8% vs. no PN=4.8%). All-cause mortality was higher among older adults with PN (P&lt;0.001; Figure ). In adjusted models, PN was significantly associated with all-cause mortality (HR 1.37, 95%CI 1.03-1.82), and this association was not attenuated after additionally adjusting for incident injurious falls or fractures (HR 1.37, 95%CI 1.03-1.81) or fractures alone (HR 1.37, 95%CI 1.03-1.82). Conclusion: PN was independently associated with all-cause mortality in older adults, but this association was not mediated by the intervening occurrence of injurious falls or fractures. These findings suggest that monofilament screening may provide critical prognostic information for mortality that is unrelated to fall risk.
Abstract P397: Hispanic Ethnicity as a Moderator of Exercise Behavior in a Mobile Health Exercise Intervention for Sedentary Adults
Authors: Madeleine Phan, Alison Ede, Alec Sequeira, Hsiang-Ling Teng, Ayla Donlin, Jacqueline Dawson
Journal: Circulation (2023)

Introduction: Mobile health (mHealth) lifestyle interventions can help mitigate cardiometabolic disease. However, Hispanic adults are underrepresented in these interventions, report lower physical activity (PA) levels and are disproportionately affected by cardiometabolic disease compared to non-Hispanic White (NHW) adults. We conducted a secondary analysis of the effects of an 8-week mHealth exercise intervention on exercise behavior in Hispanic and NHW adults. Hypothesis: A remotely delivered mHealth exercise program involving a wearable sensor, mobile application and wellness education would promote similar exercise behavior in both Hispanic and NHW adults. Methods: Thirty-eight Hispanic and 21 NHW sedentary (&lt; 60 min/week of exercise) adults were randomized (1:1:1) to 8 weeks of increasing behavioral resources: Level 1 (wellness education, n=16), Level 2 (wellness education + pre-recorded exercise videos, n=24), or Level 3 (wellness education + livestream group exercise, n=19). Participants were given a chest strap sensor (Myzone MZ-3) to use during exercise and a mobile app to interact with other participants. A weekly email delivered wellness education, feedback and PA encouragement. Level 2 (videos) and Level 3 (classes) performed 35-min 3x/wk of instructor-led, high-intensity functional training designed to improve cardiometabolic risk factors. Sensor use (3x/wk encouraged) and time spent in moderate-to-vigorous exercise effort (MVET) were captured by the MZ-3. MVET was calculated as the time spent in effort &gt;64% maximum heart rate. Baseline and post-intervention PA were captured using the International Physical Activity Questionnaire. Differences between groups were tested using univariate ANOVA with Bonferroni-adjusted t tests in post hoc analyses. Results: Hispanic participants were younger (30.6 ± 10.1 yr, mean ± SD) and performed less PA (22.6 ± 70.2 min/wk) at baseline compared to NHW (39.7 ± 16.8 yr, 90.1± 90.2 min/wk; p&lt;0.05). No differences in body mass index or gender were observed between groups at baseline (p&gt;0.05), or in weekly sensor use during the intervention (Hispanic 1.7 ± 1.8 sessions/wk, NHW 2.4 ± 1.6 sessions/wk, p&gt;0.05). Self-reported PA increased from baseline to post-intervention in both groups (p&lt;0.01), but no differences between groups were observed. However, NHW had greater moderate-to-vigorous exercise effort (86.3 ± 67.7 weekly MVET) compared to Hispanic participants (55.9 ± 66.2 weekly MVET, p&lt;0.05) throughout the intervention. Conclusion: An 8-week mHealth lifestyle program increased PA behavior in sedentary participants. However, Hispanic participants exercised at lower intensities than non-Hispanic White participants. Future work is needed to identify barriers in meeting MVPA recommendations in minority populations so that culturally tailored interventions can be developed.
Abstract P267: Examining the Relationship Between Historic Redlining and Contemporary Coronary Heart Disease Prevalence
Authors: Marcus R Andrews, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Background: Coronary heart disease (CHD) is the leading cause of death in the United States (US). Evidence supports adverse neighborhood conditions as a contributor to CHD. However, the impact of discriminatory housing practices, including historic redlining, on CHD across US cities remains understudied. Methods: Data on CHD for US cities were downloaded from the 500 Cities Project. We merged this data with census tract historic redlining data from the Mapping Inequality Project and census tract level demographic data from the American Community Survey. We used linear regressions to examine relationships between historic redlining scores and CHD adjusting for census tract level covariates. Results: 12 cities from the US were included in the analyses. After controlling for covariates, these relationships' strength and significance varied by city and region. In the Northeast/Mid-Atlantic region (Boston, Baltimore, and New York), increases in redlining scores were associated with increases in the proportion of people with CHD (Table). In the Midwest, increases in redlining scores were associated with increases in the proportion of people with CHD in Detroit and Cleveland; this relationship was significant in Detroit and marginally significant in Cleveland. There were no significant associations in Chicago. In the South, census tracts with higher redlining scores were associated with higher CHD prevalence in Miami. Paradoxical relationships were seen in Atlanta where higher redlining scores were associated with a lower proportion of people with CHD; there were no significant associations in Dallas. In the West, increases in redlining scores were associated with increases in the proportion of people with CHD in Los Angeles; relationships were not statistically significant in San Francisco or Seattle. Discussion: This is one of the first studies to suggest differential impact of historic redlining on CHD across US cities. Additional research is needed to examine potential mechanisms that explain these associations.
Abstract P456: The Cardiovascular Profile of Patients by Methamphetamine, Cocaine, Opiate, and Cannabis Use
Authors: Faye L Norby, Harpriya Chugh, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2023)

Introduction: The role of recreational substances such as alcohol, tobacco and illicit drugs in the development of clinical cardiovascular disease is established. Recent studies have started to compare cardiovascular endpoints across individual types of substances, but these studies have been limited in generalizability or do not distinguish by drug type. We conducted a cross-sectional analysis to investigate the cardiovascular profile of patients by type of substance in a large health care system. Methods: We included 346,008 adult patients who received regular care (at least 1 visit per year in 2 consecutive years) in a California health system during 2016-2020. The baseline visit was defined as the earliest visit in the 2 nd year, allowing at least 1 year for data capture. Substance use and covariates were ascertained using ICD codes from medical records at or prior to baseline. We used logistic regression to assess the association of cardiovascular characteristics by each substance use. Results: Of the 346,008 patients included, the mean age was 53 years, and 58% were female. There were 8752 (2.5%) patients with a history of substance use. The 4 most common substances were 1479 (0.43%) patients with codes for methamphetamine use, 1002 (0.29%) for cocaine, 2310 (0.66%) for opiate, and 3145 (0.91%) for cannabis. Compared to those with no history of substance use, patients with substance use were more likely to be male, and despite being younger or of similar age, had worse cardiovascular risk factors (Table). All substances had a higher adjusted odds of tobacco use and alcohol dependence. Patients with cocaine use had a higher odds of male, CKD, stroke, MI and HF (all odds ratios &gt;2), whereas the profile differed in opiate use, with the highest odds being hypertension and COPD. Conclusion: Methamphetamine, cocaine, opiate, and cannabis use each had unique cardiovascular patient profiles. These results offer insight for risk stratification and may represent treatment strategies to prevent adverse events.